The point of view of the patient organization

Prof. Francesco De Lorenzo

President ECPC-European Cancer Patient Coalition

Economic sustainability of melanoma treatments: Regulations, Health

Technology Assessment and Market

ECPC: Nothing about us, without us• Representing +370 cancer patient groups in 47 countries

• All cancers – common and rare

• Reducing disparity and inequity across the EU

• Promoting timely access to appropriate prevention, screening, early

diagnosis, treatment, care & follow-up for all cancer patients

• Increasing cancer patients' influence over European health and

research policy

• Run and governed by patients

• Encouraging the advance of cancer research & innovation

ECPC: cancer patients’recognised voice

• European Commission • Joint Action on Cancer Control – CanCon • European Commission’s Expert Group on Cancer Control • European Commission Initiative on Breast Cancer-Quality

Assurance Scheme Development Group (ECIBC/QASDG)

• European Medicines Agency • Patients’ and Consumers’ Working Party

• Health Technology Assessment International • Patients and Citizens Involvement Group (HTAi/PCIG)

Europe of Disparities in Cancer

ECPC policy strategy vs inequalities

Patient-led, scientifically based policy effort

www.ECPC.org

Europe of Disparities in Cancer

• Main message: there are still vast inequalities in access to quality treatment

– Radiotherapy – Surgery – Survivorship and rehabilitation

• Strengthen EUnetHTA

• We need to further harmonise HTAs in Europe to reach EU-wide HTA reference evaluation

• Institutionalise patients’ role in HTA bodies

• Enhanced importance to survivorship in HTA evaluation – Todaywehave8.5millionsurvivors – Many can be considered “cured” – HTA MUST take into consideration economic value of survivors

Radiation Therapy

• Across Europe, around 50% of all cancer patients should receive radiation therapy at some stage during their disease.

• However, despite being a significant part of our arsenal in combatting cancer, a large discrepancy exists between the actual and the optimal utilisation of radiation therapy in Europe.

European Cancer Patient Coalition

And its not just drugs! Inequality in radiotherapy capacity across Europe

European Cancer Patient Coalition

Radiation oncology capacity • Significant deficits in access to modern

radiotherapy equipment in Europe

• Similar picture when staffing levels are evaluated, thus translating into unequal access to cancer care for European patients

• Deficiencies are experienced not only in Southern and Eastern European countries, but also in Western European countries

European Cancer Patient Coalition

ACCESS TO SURGERY

• Delivery of “standard-of-care” surgery ranges from 9% to 78% across Europe and inequalities are evident, even between countries with medium-to-high expenditure on health

• Delivering surgical care in cancer centres where specialist surgical oncologists perform optimal numbers of procedures with appropriate complexity provides the best opportunity to ensure improved outcomes.

European Cancer Patient Coalition

Best Practice

• Establishing optimal benchmarking standards for surgical oncology at European level, eg EURECCA(EUropean REgistry of Cancer Care), will help reduce the current inequalities experienced by cancer patients,

• Information sources such as the Italian Oncoguida (www.oncoguida.it) provide patients with accurate activity data to aid in their choice of surgical centre and should act as a blueprint for other MS

European Cancer Patient Coalition

We live a Paradox!

• Availability of innovative & effective drugs but not to all patients across the EU

• Unacceptable delays in the reimbursement of new lifesaving drugs across Europe

Innovative Medicines

• Increased understanding of disease biology is fuelling a “personalised cancer medicine” revolution.

• However, for a drug like transtuzumab, which targets an “out of control” breast cancer gene and has led to a new standard of care, there are marked differences in time to approval/ reimbursement across EU MS, thus accentuating inequalities in access to optimal cancer care

European Cancer Patient Coalition

European Cancer Patient Coalition

European Cancer Patient Coalition

I principali risultati

➢Per il completamento del percorso autorizzativo trascorrono per i farmaci studiati in media 1.070 giorni, ovvero tre anni, così suddividi:

➢fase europea 400 giorni; ➢fase di invio all’Aifa 40 giorni; ➢fase nazionale 530 giorni (290 per il lavori della

Cts, 90 per il lavori della Cpr, 150 per la pubblicazione in Gazzetta);

➢fase regionale 100 giorni per l’inserimento (ove presente) nei prontuari regionali.

ECPC: leverages on European institutions for a solution to delays in access to cancer drugs

• World Cancer Day 2015 declaration: 160 MEPs supported ECPC to fight inequalities in cancer care

• Debate in Plenary, European Parliament September 2015: MEPs ask the Commissioner for more sustainable healthcare systems & denounced problem of access to innovative treatments

• Written declaration 30/2015: ECPC & 19 MEPs ask the European Parliament to take a position on sustainability of healthcare, requesting the Commission to do more to harmonise HTA process at EU level

• Amendments to the EMA regulation 726/2004: ECPC supported the amendments to the regulation to pave the way for the EMA to centralise the HTA assessment at the EU level and increase harmonisation

ECPC’s supported amendments to the EMA Regulation 726/2004

We are asking to: •Overcome the unacceptable delays in access to innovative lifesaving drugs

•Cut inefficiencies, duplications (more than 90 HTA bodies exist today in Europe, working on the same set of data!)

•Produce a legally binding, pan-European relative clinical benefit assessment

•In parallel with EMA evaluation, but produced by a different body (new agency)

•Building on the work done by the Joint Action on HTA – EUnetHTA

•Better include the patients in the HTA process to asses the true meaning of value

Legal limits for EU harmonization of HTA

• V. Andriukaitis: “Keen to foster discussions & support cooperation between Member States in these areas (HTA, harmonization of NCP), so as to make medicine more accessible to patients” – Cancer World-Sept. 2015

• Example of Belgium, the Netherlands for exchange of information about pricing

• ECPC welcomes statement of Commissioner Andriukaitis, calling for a revision of the EU Treaties to give more powers to the EU

• Absolute need to harmonise HTA at European Level

• EUropean network for Health Technology Assessment (EUnetHTA)

European Cancer Patient Coalition

Health Technology Assessment (HTA)

Several other disciplines besides EBM must be involved:

•outcomes research,

•pharmacoeconomics,

•medical decision making,

all together form today’s HTA

HTA cannot be solely a technical evaluation

Is HTA purely technical?

J.F.P. Bridges, Chr. Jones-Johns Hopkins Bloomberg School of Public Health-3rd Annual Meeting of HTAi Intl-2006

Patients: an integral part of HTA evaluation

• Is it enough to give a seat at the decision making table to “professionalized” patients?

• Limited adoption of this hesitant approach by HTA agencies

• The patient: most important stakeholder in decision making for HTA

• Doctors: key in medical decision making-trusted by patients

Patients: ready to be full partners of HTA process

E-patients=empowered, equipped, enabled, engaged patients of today request

• Focus on the patient’s problems• Take the patient’s perspective• Accomodate the patient’s

preferences

The best drug that does not reach the patient

in time & at reasonable price is of no use to the patient

European Cancer Patient Coalition

Thank for your attention

CHAMPIONING THE INTERESTS OF EUROPEAN CANCER PATIENTS

email francesco.delorenzo@ecpc.org

@cancereu

European Cancer Patient Coalition

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